Medicines and treatments for atrial fibrillation
Anticoagulant medicines and other medicines and treatments are available for people with both intermittent and permanent atrial fibrillation (AF) to reduce their risk of stroke and other blood clot-related complications.
Which anticoagulant medicines are used to prevent stroke?
Anticoagulant medicines that can be prescribed for people with AF to reduce the risk of stroke include:
- warfarin (Coumadin and Marevan)
- dabigatran (Pradaxa)
- rivaroxaban (Xarelto)
- apixaban (Eliquis)
- aspirin (e.g. Astrix, Cartia).
Warfarin is the most commonly-used anticoagulant for treating AF. Dabigatran, rivaroxaban or apixaban can also be used to prevent blood clots in people with atrial fibrillation.
If you are already taking warfarin, and your INR is stable, there is little or no benefit in switching to another anticoagulant.
From 1 August 2013, rivaroxaban will be available on the Pharmaceutical Benefits Scheme (PBS) for preventing stroke in people with AF. Dabigatran and apixaban are currently not subsidised by the PBS for preventing stroke in people with AF.
Low dose aspirin may be more appropriate for some people, for example those with a low risk of stroke.
Which anticoagulant medicine is right for me?
If you have AF, the medicine that is most suitable for you depends on your risk of having a stroke, other medical conditions and risk factors you might have. This will differ from person to person according to individual circumstances. After discussing your individual risks and the benefits of treatment, you and your doctor can decide which medicine is most suitable for you.
Your doctor will check your risk factors for stroke and also assess your individual risk of side effects. Choosing the right medicine is a matter of balancing the benefit of preventing a stroke against the risk of any side effects. If you have a high risk of side effects — particularly bleeding — or if your risk of stroke is low, then some medicines may not be suitable for you.
Ask your doctor whether you have any other risk factors for stroke.
Other treatments for atrial fibrillation
In addition to anticoagulant medicines, your doctor may prescribe other medicines and treatments to help control your fast heartbeat (rate) or its irregular beat (rhythm). The treatment chosen depends on your type of atrial fibrillation — whether intermittent or permanent — your symptoms, and your other medical conditions (e.g. heart disease, coronary artery disease, valvular heart disease).
Treatment options may include:
- medicines to slow down the heart rate — such as a beta-blocker (e.g. sotalol), a calcium channel blocker (e.g. verapamil or diltiazem) or less commonly, digoxin
- medicines to correct the rhythm — e.g. amiodarone or flecainide
- cardioversion, where an electric shock is given to the heart to correct the rhythm
- catheter ablation, a procedure where a catheter (a thin wire) is inserted into the heart. The catheter detects abnormal electrical signals and is then used to burn off the small areas of the heart that are producing the abnormal impulses.
- surgery to insert a pacemaker.
If you have atrial fibrillation, ask your doctor to discuss all the treatment options with you.
Phone for medicines information
Call NPS Medicines Line on 1300 MEDICINE (1300 633 424) to get information about your prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and mineral supplements) from a pharmacist. Your call will be answered by healthdirect Australia.
- Unit for Medication Outcomes Research and Education (UMORE). Atrial fibrillation. Tasmania: University of Tasmania, June 2009. www.anticoagulation.com.au/AboutWarfarin/WhyTakeWarfarin/AtrialFibrillation/tabid/79/Default.aspx (accessed 17 May 1012).
- Saxena R, Koudstaal PJ. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack. Cochrane Database Syst Rev. 2004;(2):CD000185. onlinelibrary.wiley.com/doi/10.1002/14651858.CD000185.pub2/abstract (accessed 17 May 2012).
- Gallus AS, Baker RI, Chong BH et al. Consensus guidelines for warfarin therapy. Med J Aust 2000;172(12):600–5. www.mja.com.au/public/issues/172_12_190600/gallus/gallus.html (accessed 17 May 2012).
- Borosak M, Choo S, Street A. Warfarin: balancing the benefits and harms. Aust Prescr 2004;27:88–92. www.australianprescriber.com/magazine/27/4/88/92 (accessed 17 May 2012).
- Dabigatran (Pradaxa) for stroke prevention in patients with non-valvular atrial fibrillation. NPS RADAR, 2011. www.nps.org.au/health_professionals/publications/nps_radar/2011/august_2011/dabigatran_af (accessed 17 May 2012).
- Dabigatran (Pradaxa) for preventing stroke in people with atrial fibrillation. NPS Medicine Update 2011. www.nps.org.au/consumers/publications/medicine_update/issues/dabigatran_af (accessed 26 April 2012).
- Therapeutic guidelines: Atrial fibrillation. Therapeutic Guidelines Ltd; 2013. www.tg.org.au (accessed 13 June April 2013).
- Rossi S, ed. eAMH [online]. Adelaide: Australian Medicines Handbook, January 2013.